Bill
S 762
Mandates upfront disclosure of plan participation and estimated charges for non-emergency care; insurers must notify patients of out-of-pocket costs, reducing surprise bills.
Status and context
- Bill number: S 762 (filed Jan 17, 2025; introduced Feb 27, 2025).
- Current procedural note: listed as “SUBSTITUTED BY A925A.” Referred to Financial Services and the Judiciary; hearings scheduled (e.g., 07/15/2025).
- Purpose: to standardize and streamline pre-service notices and cost-disclosure obligations by health care providers and health insurers to improve consumer transparency and limit unexpected patient liability.
Main purpose and intent
- Increase advance notice and transparency about whether a provider participates in a patient’s health plan and about expected patient financial responsibility for scheduled non-emergency admissions, procedures, or services.
- Reduce surprise bills and enable patients to compare options (e.g., seek participating providers).
Key provisions and requirements
- Participation disclosure: When scheduling a non-emergency admission/procedure/service (or on request), a health care provider must disclose whether it participates in the patient’s health benefit plan. For a continued course of treatment, one initial documented disclosure suffices for subsequent visits unless the provider’s participation status changes.
- Participating providers: If the provider participates in the patient’s plan, the provider must give the patient’s insurer a good-faith estimate of expected billing/diagnostic codes. The insurer must then notify the patient of the estimated out‑of‑pocket amount in clear language (per PHS Act §2799B–6 / 42 U.S.C. §300gg‑136). Timing for insurer notices: within 3 business days when the service is scheduled ≥10 days before the service, or within 1 business day if fewer than 10 days remain.
- Non‑participating providers / uninsured patients: The provider must give a good‑faith estimate of charge amounts and any facility fees, tell the patient they will be responsible for amounts not covered, and advise the patient they might obtain a lower cost from a participating provider. Timing requirements for furnishing estimates are specified based on how far in advance the appointment was scheduled (see bill text).
- Compliance via federal forms: Providers may comply by following federal notice rules (PHS Act §2799B–6 as implemented at 45 C.F.R. §149.610(c)).
- Billing consequence for failure to notify: If a non‑participating provider (or a provider treating an uninsured patient) fails to provide the required notifications, the provider may not bill the insured beyond applicable copay, coinsurance, or deductible amounts that would apply if the insured had used a participating provider.
- Enforcement and penalties: The state commissioner shall implement/enforce the section. Penalties for non‑compliance may be imposed up to $5,000 per instance against providers or insurers, but not where CMS or the state Division of Insurance has already penalized the same violation.
Timing/implementation
- Subsection governing insurer estimate notices (section 1(a)(2)) becomes effective upon the effective date of federal regulations implementing 42 U.S.C. §300gg‑136.
- Other timing and enforcement provisions become effective upon enactment and agency rulemaking/implementation.
Who is affected
- Patients and prospective patients (better cost visibility, ability to compare providers).
- Health care providers (participating and non‑participating) — added documentation and notice obligations; potential liability limits if notices omitted.
- Health insurance carriers — obligation to provide patient cost estimates within set timeframes when given provider coding information.
- State agencies (enforcement responsibility) and coordination with federal regulators.
Potential impacts
- Greater pre‑service transparency and fewer surprise bills for scheduled non‑emergency care.
- Administrative and technical burdens on providers and insurers to produce timely good‑faith estimates and to exchange code/estimate information.
- Interaction with federal transparency rules; effective timing depends on federal rule implementation.
For precise compliance timelines, definitions (e.g., “emergency medical condition”), and the exact text of timing requirements and penalties, consult the bill text and any implementing regulations.
Compiled from official sources — confirm details with the bill’s official record.
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